Evidence for pulmonary rehab reflected in updated COPD-X guidelines

The evidence for the benefits of pulmonary rehabilitation has been strengthened in the latest update of the Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD-X).

Professor Ian Yang, chair of the Lung Foundation Australia COPD Guidelines Committee, told the limbic the multidisciplinary intervention was already known to reduce breathlessness, and improve exercise capacity and quality of life.

“A recent systematic review – level I evidence – published in Chest in 2016, has also provided further evidence that pulmonary rehabilitation reduces the frequency of hospitalisations for exacerbations of COPD, compared to usual care,” he said.

“Our Lung Foundation Australia COPD Guidelines Committee has specifically updated the Executive Summary of COPD-X, to purposefully highlight these benefits of pulmonary rehabilitation, to assist clinicians to appropriately refer patients for this effective intervention.”

The updated guidelines have separated the statements for strong evidence of clinical benefit with pulmonary rehabilitation from lesser quality evidence that the intervention is cost effective.

Other changes in the latest COPD-X guidelines included:

  • New meta-analyses evidence regarding the increased risk of pneumonia with use of inhaled corticosteroids.
  • A Cochrane review showing ‘triple’ therapy – tiotropium plus LABA/ICS combination therapy – decreases hospital admissions from all causes compared to tiotropium alone.
  • A combination of beclometasone/formoterol/glycopyrronium in a single inhaler – not currently available in Australia – may be more beneficial than ICS/LABA in patients with severe COPD and frequent exacerbations.
  • A new section highlighting the increased risk of post-operative pulmonary complications in COPD patients after thoracic or non-thoracic surgery and the need for pre-surgery optimisation.
  • A recommendation for long-term continuous oxygen therapy only in patients who are significantly hypoxaemic.
  • A call to support the use of antidepressant medication in conjunction with pulmonary rehabilitation for improvements in depression and dyspnoea-related disability.
  • A Cochrane review showing no difference between nebulisers or pressured metered dose inhalers as the delivery device for bronchodilators during exacerbations.

Click here to view a full copy of the updated guidelines.

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